Impossible primary referral to the major trauma center of an integrated trauma system: a case of exsanguinating trauma treated in a Spoke hospital.

Trauma Emerg Care, 2017. Volume 2(3): 2-3 doi: 10.15761/TEC.1000132

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Figure 1. Intra-operative image of vascular prosthetic bypass repair.

Case presentation: we present a case in which massive bleeding by traumatic penetrating injury in zone 1 of the neck made impossible the primary referral to Major Trauma Center for clinical and logistical circumstances. The only available choice was to bring the patient to the nearest Spoke hospital where optimal interaction between Helicopter crew and Spoke hospital personnel, used working with preferred partners, was crucial for good patient outcome. Effective communications by phone during ambulance transport to the nearest hospital, not used to treat severe trauma cases, was effective in fulfilling lack of knowledge between team clinicians. Direct access to Operating Theater by-passing Emergency Department acceptance for surgical damage control of bleeding, together with Early Coagulative Support Protocol activation and hypotensive resuscitation strategy where coordinated allowing an updated and effective treatment.

Figure 2. 1: HEMS base. 2: event scene. 3: spoke acute care “Infermi” hospital in Rimini. 4: Major Trauma Center “M. Bufalini” hospital in Cesena. 1-2 violet trace: flight trace to the scene. 2-3 violet trace: ambulance trace to Spoke “Infermi” hospital in Rimini.

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